The overlooked side of myasthenia gravis: the non-motor manifestations-a comprehensive review.

Myasthenia gravis (MG) is a chronic autoimmune disorder of the neuromuscular junction characterized by fluctuating muscle weakness due to antibody-mediated impairment of acetylcholine receptor (AChR) function. Traditionally, MG has been regarded as a disease primarily affecting skeletal muscles, and most research has focused on its motor manifestations. However, increasing evidence suggests that MG is a systemic disorder that can also present with a wide range of non-motor symptoms, which may significantly affect both quality of life and disease outcomes. This review provides a comprehensive overview of the non-motor manifestations of MG, including autonomic, cognitive, psychiatric, sensory, and gastrointestinal disturbances, as well as cardiovascular and sleep abnormalities. We discuss the underlying pathophysiological mechanisms that may explain these symptoms, focusing on immune dysregulation, autonomic imbalance, and potential antibody cross-reactivity with nicotinic acetylcholine receptor subtypes in non-skeletal tissues. Moreover, diagnostic and therapeutic implications are addressed, emphasizing the need for multidisciplinary management to adequately assess and treat these often-overlooked aspects of the disease. Although current evidence remains limited, mainly derived from small cohorts or case reports, the recognition of non-motor symptoms in MG represents an essential step toward a more holistic understanding of the disease. Future research should aim to elucidate their prevalence, underlying mechanisms, and treatment strategies through well-designed, prospective studies. Overall, this review highlights the importance of incorporating the assessment of non-motor manifestations into routine MG care to improve patient outcomes and quality of life.